| NPI | 1144787623 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251P0200X Physical Therapist Pediatrics (Licence: GA PTO13902) |
| Additional Taxonomies | 261QP2000X Clinic/Center Physical Therapy (Licence: TN 10531) |
| Enumeration Date | 2019-02-21 |
| Last Update Date | 2022-03-01 |